Disclosure-and-offer (D&O) has attracted wide attention as a potential approach for increasing access to timely medical injury compensation, reducing medical liability costs, and better linking the malpractice claims investigation and evaluation process to patient safety improvement. D&O programs, which are currently operated by a handful of liability insurers across the country, support physicians in disclosing unanticipated care outcomes to patients and create a process for rapid investigation of claims and provision of early offers of compensation in appropriate cases. Further, it is hoped that with a system that improves trust, reduces fear, and improves patient safety there will be less drive to practice defensive medicine. Beth Israel Deaconess Medical Center (BIDMC) seeks a planning grant to support a joint initiative with the Massachusetts Medical Society, Removing Barriers to Disclosure-and-Offer Models. The goals of the project are to: (1) determine the barriers to implementation of a disclosure-and- offer (D&O) model patient safety initiative in Massachusetts through in-depth key informant interviews with stakeholder group representatives in the state;(2) develop strategies for overcoming barriers to implementation of a D&O model patient safety initiative in Massachusetts;(3) design a Roadmap to medical liability reform and patient safety in Massachusetts based on information regarding barriers and strategies for overcoming them;(4) examine the degree to which the D&O model patient safety initiative implementation plan for Massachusetts has applicability for other states. The final Roadmap created by this study will reflect the best available evidence about effective design elements of extant D&O programs and will include strategies for initiating and implementing programs within healthcare institutions and liability insurers of various kinds. The Roadmap will be widely disseminated to key informants throughout Massachusetts for maximum impact. A long-term objective of this planning grant is the implementation of the final Roadmap throughout Massachusetts in order to measure the impact of a new model on the fear and anxiety among health care providers as they function in new systems characterized by prompt and open communication. PUBLIC HEALTH RELEVANCE: Disclosure-and-offer (D&O) has attracted wide attention as a potential approach for increasing access to timely medical injury compensation, reducing medical liability costs, and better linking the malpractice claims investigation and evaluation process to patient safety improvement. Beth Israel Deaconess Medical Center (BIDMC) seeks a planning grant to support a joint initiative with the Massachusetts Medical Society (MMS), Removing Barriers to Disclosure-and-Offer Models. The main goal of the project is to develop a Roadmap for implementation of a D&O model patient safety initiative in Massachusetts, with potential applicability to other states, in an effort to create a new medical liability system that improves trust, reduces fear, improves patient safety, and diminishes the drive for physicians to practice defensive medicine.